Provider Demographics
NPI:1073701850
Name:NORIEGA, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:NORIEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13117 RIVERCREST DR
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60418-4419
Mailing Address - Country:US
Mailing Address - Phone:708-371-1190
Mailing Address - Fax:708-448-8812
Practice Address - Street 1:13117 RIVERCREST DR
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60418-4419
Practice Address - Country:US
Practice Address - Phone:708-371-1190
Practice Address - Fax:708-448-8812
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036049076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
21623955OtherBLUE CROSS BLUE SHIELD
ILC41837Medicare UPIN
IL471350Medicare PIN